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Minnesota Department of Public Safety <br />G <br />Alcohol and Gambling Enforcement Division <br />► <br />445 Minnesota Street, Suite 222, St, Paul, MN 55101 <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />Alcohol 8, Gambling Enforcement <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization fate organized Tax exempt number <br />Church of 5t. Genevieve 1853 I 41-1417861 <br />Address <br />City State Zip Code <br />7087 Goiffon Rd <br />Centerville Minnesota 55038 <br />Name of person making application <br />Business phone Home phone <br />Susle Irlbeck <br />651-429-7937 651-472-3456 <br />Date(s) of event <br />Type of organization ❑ Mlcrodistillery 0 Small Brewer <br />August 20, 2023 <br />❑ Club [] Charitable Z Religious ❑ Other non-profit <br />Organization officer's name <br />City State Zip Code <br />Fr, Greg Esty <br />Centerville Minnesota j 55038 <br />Organization officer's name <br />City State Zip Code <br />Minnesota <br />Organization officer's name <br />City State Zip Code <br />Minnesota <br />Organization officer's name <br />City State Zip Code <br />Minnesota <br />Location where permit will be used, If an outdoor area, describe. <br />grounds and building at 6995 Centerville Rd, Centerville, Our Parish Community Center <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />If the applicant will carry liquor liability Insurance please provide the carrier's name and amount of coverage. <br />The Catholic Mutual Relief $500,000 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITrINGTO ALCOHOL AND GAMBLING ENF+ORCEWNT <br />City or County approving the Iicense <br />Fee Amount <br />Date Fee Paid <br />Date Approved <br />Permit Date <br />City or County E-mailAddress <br />City or County Phone Number <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE; Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY, <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITYICOUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE.TEMPORARYAPPLICATION STATE,MN.US <br />